Laser resurfacing: a safe and predictable method of skin resurfacing

Skin resurfacing with lasers for skin restoration has been the most exciting advance in cosmetic surgery in the past 2 years. This method has effectively replaced chemical peel and dermabrasion as modes for skin rejuvenation, yet surprisingly, very little has been published on its effectiveness. Our aim is to delineate clear indications, methods and results of laser skin resurfacing. Laser resurfacing has evolved over the past 13 years and our current method has emerged from this experience. This method has been employed on 258 consecutive patients treated over the past 2 years. A total of 201 patients were treated for photodamaged skin, 53 for facial acne scarring and four for post-surgical scars. Each of these conditions has in common the pathological finding of contour irregularity of the involved abnormal skin. The CO2 Ultrapulse laser's advantage is the predictable ability to vaporize the upper layer of elevated skin, tighten collagen bundles and induce a local inflammatory reaction with epithelial proliferation. This paper presents a clear, concise, and conservatively oriented technique, including pre- and post-operative care of laser skin resurfacing. The technique presented is conceived to correct precisely the underlying pathological condition and can be used in conjunction with other cosmetic procedures. A total of 200 patients underwent full face resurfacing, 41 periorbital, 13 perioral and four for facial scars. Of the patients, 78% were female and 22% were male. The results of each patient were judged by an independent observer. Some 92% were found to have either an excellent or very good result; 2% were judged to be satisfactory; and 6% were from outside the region or were lost to follow-up. Minor complications included 12% transient post-inflammatory hyperpigmentation, 3% acute acne and 1% herpes type 1. There were no major complications, including hypertrophic scarring. A total of 15% required some type of secondary touch-up resurfacing. Our method of laser skin resurfacing offers a consistent method for dramatic improvement of facial skin quality for those patients with photodamage and acne scarring, while minimizing risk.